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INTRODUCTION: The aim of this retrospective study was to assess the efficacy of Salivary Bypass Tube (SBT) for preventing pharyngo-cutaneous fistula (PCF) in a recent cohort of patients who underwent primary and salvage total laryngectomy (TL). METHODS: A consecutive series of 133 patients who underwent total laryngectomy between 1997 and 2019 was reviewed. The incidence of PCF was compared between patients who did not receive SBT (nSBT group; n = 55) and those preventively receiving SBT (SBT group; n = 78) in both primary and salvage TL. Risk factors for PCF were evaluated in a univariate and multivariate analyses. RESULTS: The overall PCF rate was 30%. Preoperative characteristics were similar between the nSBT and SBT groups, except for older age (p = 0.016), lower preoperative hemoglobin (p = 0.043), and lesser neoadjuvant chemotherapy (p = 0.015) in the SBT group. The rate of PCF the nSBT group, was 41.5%, compared to 21.8% in the SBT group (p = 0.020). In multivariate analysis, only the use of SBT was associated with lower risk of PCF (OR = 0.41 (95% CI 0.19-0.89), p = 0.026). This effect was verified only in the subgroup of patient operated for salvage TL (OR = 0.225; 95% CI 0.09-0.7; p = 0.008). CONCLUSION: The use of SBT in our series in salvage TL, appears to be associated with a decreased risk of PCF.
Assuntos
Fístula Cutânea , Neoplasias Laríngeas , Doenças Faríngeas , Idoso , Fístula Cutânea/epidemiologia , Fístula Cutânea/etiologia , Fístula Cutânea/prevenção & controle , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/etiologia , Doenças Faríngeas/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos RetrospectivosRESUMO
AIM: Among 339 patients operated for benign tumor of the parotid gland: the recurrences and the postoperative complications rates were compared WITH those published in literature. MATERIALS AND METHODS: About 339 patients operated: 274 primarily and 65 for recurrence or residual tumor. VARIABLES: sex, age, surgical techniques, pre- or postoperative radiotherapy, histology, size and localization of the tumors, disease free intervals, recurrences and postoperative complications. RESULTS: 177 men and 162 women. Median age: 55 years and mean follow-up: 10.4 years. About 39 patients had adjuvant radiotherapy (11.5%). After primary surgery, four patients experienced recurrences (1.5%). After salvage surgery, eight patients recurred (12.3%). The recurrence rate was the highest among pleomorphic adenomas. Facial paralysis was more frequent after salvage surgery. DISCUSSION: Recurrence rate 10 years later was lower after primary than after salvage surgery (p = 0.01). There was no relation between adjuvant radiotherapy and recurrence rate probably because the low rate of recurrences. CONCLUSION: Recurrence rate after primary surgery is lower after superficial or total parotidectomy than after other surgical techniques. Pleomorphic adenomas have the highest rate of recurrences. Age and sex have no significant influence over the rate of recurrences. The most frequent postoperative complications are facial paralysis and Frey's syndrome.
Assuntos
Adenoma/terapia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/terapia , Complicações Pós-Operatórias/epidemiologia , Adenoma/mortalidade , Adenoma/patologia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/mortalidade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Indocyanine green (ICG)-guided surgery has proven effective in the identification of neoplastic tissues. The effect of radiation therapy (RT) on lymph node fluorescence after intravenous injection of ICG has not been addressed yet. The objective of this study was to evaluate the influence of RT on node fluorescence during neck dissection in head and neck squamous cell carcinoma (HNSCC). RESULTS: Twenty-four patients with planned neck dissection for HNSCC were prospectively enrolled. Eleven were included without previous radiation therapy and 13 after RT. ICG was intravenously administered in the operating room. The resected specimen was analyzed by the pathology department to determine the status of each resected lymph node (invaded or not). The fluorescence of each resected node was measured in arbitrary units (AU) on paraffin blocs. The surface area (mm2) of all metastatic nodes and of the invaded component were measured. The values of these surface areas were correlated to fluorescence values. A total of 707 nodes were harvested, the mean fluorescence of irradiated nodes (n = 253) was 9.2 AU and of non-irradiated nodes (n = 454) was 9.6 AU (p = 0.63). Fifty nodes were invaded, with a mean fluorescence of 22 AU. The mean fluorescence values in the invaded irradiated nodes (n = 20) and the invaded non-irradiated nodes (n = 30) were 19 AU and 28 AU (p = 0.23), respectively. The surface area of metastatic nodes and of the invaded component were correlated to fluorescence values even after previous RT (p = 0.02). CONCLUSION: No differences were observed between the fluorescence of irradiated and non-irradiated lymph nodes, including invaded nodes. ICG-guided surgery can be performed after failed RT. TRIAL REGISTRATION: EudraCT ref. 2013-004498-29, registered 29 November 2013. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-004498-29.
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A 51-year-old male was found with bilateral thyroid nodules on ultrasonography neck imaging. The largest nodule, measuring 23 × 26 × 35 mm, was located in the left lobe and was classified as EU-TIRADS 4. Thyroid function tests were normal, as were serum levels of parathormone, Chromogranin A, carcinoembryonic antigen and calcitonin. The nodule was cold on thyroid scintigraphy. Fine-needle aspiration of the nodule did not demonstrate cellular atypia. High focal uptake was found on both 111In-DTPA-octreotide scintigraphy and 68Ga-DOTATATE PET/CT. Histopathological analysis showed a microfollicular adenoma without malignancy. Immunohistochemical staining did not suggest neuroendocrine neoplasia or C cell hyperplasia. However, high expression of somatostatin receptor 2 (SSTR2) was observed in the microfollicular adenoma compared to the surrounding healthy tissue, with predominant localization in the endothelial cells and at the secretory pole of the thyroid epithelial cells in contact with blood vessels. High focal thyroid uptake on 68Ga-DOTATATE PET/CT can be observed in benign thyroid nodules due to an overexpression of SSTR by endothelial cells. However, incidental focal thyroid uptake on SSTR imaging requires further investigations to rule out thyroid malignancy.
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BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is often used to provide nutritional support in locally advanced head and neck cancer patients undergoing multimodality treatment. However, there is little published data on the impact of prophylactic versus reactive PEG. PEG placement may affect swallowing-related physiology, function, and quality of life. The Swall PEG study is a randomized controlled phase III trial testing the impact of prophylactic versus reactive PEG on patient-reported outcomes in terms of swallowing and quality of life in oropharyngeal cancer patients. METHODS: Patients with locally advanced oropharyngeal cancer receiving chemo-radiotherapy will be randomized to either the prophylactic or reactive PEG tube group. Randomization will be stratified by human papillomavirus (HPV) status and unilateral versus bilateral positive neck lymph nodes. The primary objective of the study is the patient's reported outcome in terms of swallowing (MD Anderson Dysphagia Inventory (MDADI)) at 6 months. Secondary objectives include health-related quality of life, dosimetric parameters associated with patient-reported outcomes, chemo-radiation toxicities, PEG tube placement complications, the impact of nutritional status on survival and toxicity outcomes, loco-regional control, overall survival, the impact of HPV and tobacco smoking on survival outcomes and toxicities, and the cost-effectiveness of each treatment strategy. DISCUSSION: Findings from this study will enhance clinical evidence regarding nutritional management in oropharyngeal cancer patients treated by concurrent chemo-radiation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04019548, study protocol version 2.0_08/08/2019. Registered on 15 July 2019.
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Transtornos de Deglutição , Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Humanos , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Deglutição , Qualidade de Vida , Resultado do Tratamento , Neoplasias Orofaríngeas/radioterapia , Neoplasias de Cabeça e Pescoço/terapia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Quimiorradioterapia/efeitos adversos , Medidas de Resultados Relatados pelo PacienteRESUMO
Chondrosarcomas of the spine are rare and are difficult to treat. Three cases of chondrosarcoma are presented, and a series compiling similar cases reported in the literature was established. This study shows that chondrosarcomas of the spine are generally smaller, more difficult to excise, and followed by higher local recurrence compared with chondrosarcomas in the peripheral skeleton. The most important prognostic factor for local control is wide or marginal tumour resection.
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Condrossarcoma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Condrossarcoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias da Coluna Vertebral/patologiaRESUMO
BACKGROUND: Indocyanine green (ICG) has not been studied during therapeutic lymph node dissections after intravenous injection. The purpose of this study was to explore the distribution of ICG in lymphatic nodes during neck dissection. METHODS: Eleven patients requiring neck dissection with or without resection of the primary lesion were included. ICG was intravenously injected at induction time of anesthesia. Imaging was performed before and after surgical resection. Fluorescence was measured in arbitrary units (AUs) in the pathology department. Mixed linear model and generalized estimating equations (GEEs) were used. RESULTS: Mean fluorescence of invaded nodes was 22.6 AUs (SD = 24.9) and 3.9 AUs (SD = 8.1) in negative nodes (p = .016). After adjustment for the size of the node, the risk of invasion when fluorescence was observed was 12.2 (95% confidence interval [CI] = 5.3-28.2; p < .0001). CONCLUSION: This study demonstrates the feasibility of ICG to bring a contrast during surgery between healthy and invaded nodes after i.v. injection. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1833-E1837, 2016.
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Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Esvaziamento Cervical , Imagem Óptica , Adulto , Idoso , Estudos de Viabilidade , Corantes Fluorescentes , Humanos , Verde de Indocianina , Injeções Intravenosas , Pessoa de Meia-IdadeAssuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Verde de Indocianina/administração & dosagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Cirurgia Assistida por Computador/métodosAssuntos
Carcinoma de Células Escamosas/diagnóstico , Coloides/administração & dosagem , Verde de Indocianina/administração & dosagem , Neoplasias Bucais/diagnóstico , Nanopartículas/administração & dosagem , Linfonodo Sentinela/diagnóstico por imagem , Adulto , Idoso , Humanos , Estudo de Prova de ConceitoRESUMO
Contegra (Medtronic, Minneapolis, MN) conduits are routinely used in cases of right ventricular outflow tract reconstruction during congenital heart surgery. We report two cases of Q fever endocarditis involving Contegra conduits. Surgical treatment and distinct aspects of both unusual cases are described.
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Bioprótese/efeitos adversos , Endocardite/etiologia , Veias Jugulares/transplante , Febre Q/complicações , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Animais , Bovinos , Criança , Endocardite/cirurgia , Humanos , MasculinoRESUMO
Parathyroid carcinoma is a rare disease, which accounts for less than 1% of all case of primary hyperparathyroidism and is usually not detected until the time of surgery or thereafter. For most patients preoperative staging is not available. A radical excision remains the standard management; the place of adjuvant radiotherapy is not well established yet. Local recurrence and/or the metastases are unfortunately frequent. The present paper presents an up to date review of the literature illustrated by three clinical cases.